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EOC Situation Report #5 - Influenza A(H1N1) In The Americas (Mexico, The United States, Canada)

  • Phase 4 remains in effect and, as the situation rapidly evolves, countries are responding to this alert.
  • Several other countries are reporting confirmed cases, and others are investigating suspected cases. Mexico has reported the largest number of cases and deaths.
  • United Nations Secretary-General Ban Ki-moon announced yesterday that the World Bank and other UN development and humanitarian agencies will provide funding to countries needing additional resources to combat an epidemic.
  • Countries, with assistance from PAHO/WHO, are carrying out intense epidemiological and laboratory investigations. A daily epidemiological report is daily posted on the PAHO website .

Status of the Region

  • Mexico has reported 26 confirmed cases with 7 deaths. Geographical distribution of confirmed cases: 17 DF (4 deaths); 7 State of Mexico (2 Deaths); 1 Oaxaca (1 death), 1 Veracruz. Suspected cases are 1324 with 84 deaths.
  • The United States Government has reported 64 laboratory confirmed human cases of Influenza A(H1N1) A(H1N1): California (10 cases), Kansas (2 cases), New York City (45 cases), Ohio (1 case) and Texas (6 cases). No deaths have been reported.
  • Canada has reported 6 cases (4 in Nova Scotia; 2 British Columbia), with no deaths.

WHO and PAHO Response

  • PAHO today hosted a teleconference with Minister of Health from throughout Latin America and the Caribbean to exchange information and address questions raised by the epidemic. PAHO/WHO is constantly briefing its partners by various media and has prepared guidelines and information documents on the topic.
  • PAHO/WHO continues to mobilize multidisciplinary teams of experts to Mexico, including epidemiologists, disasters experts, logisticians and communicators.
  • The WHO SHOC room and PAHO Emergency Operations Center (EOC) remain activated.

WHO Pandemic Phase

Figure 1: The current WHO phase of pandemic alert is 4

Overall Recommendations

  • WHO/PAHO advises no restriction of regular travel or closure of borders.
  • There is no risk of infection from this virus from consumption of pork and pork products.
  • Individuals are advised to wash their hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.
  • It is strongly recommended that people who are sick should postpone travel. People who have recently traveled, and have become ill, should seek medical attention.

At Risk Areas

Summary of locations with reported deaths (red triangles) and confirmed cases (blue icons).


  • WHO has published guidelines for the surveillance of human infection for National Focal Points for the International Health Regulations (IHR). It includes a case definition  for surveillance purposes.
  • WHO information on the use of antiviral treatments for influenza including tamiflu is available online .

Instructions for shipments of samples

  • WHO has published recommendations on how to ship Influenza A(H1N1) specimens and virus isolates to WHO Collaborating Centers for influenza. More information on sampling and shipping of influenza clinical specimens and virus isolates is available at the WHO website .
  • Please note that in the Americas all countries have prepared national influenza pandemic preparedness plans which contain information on national and regional reference laboratories for receiving and testing samples for influenza.


  • The situation is very fluid, evolving every day.
  • All cases reported worldwide are mild cases or not confirmed; to date only Mexico has reported some fatal cases.
  • The Director-General of WHO has raised the pandemic phase level from 3 to 4. For more information on the different phase levels please check Annex 1 below.


Phase WHO Pandemic Influenza Preparedness and Response Guidance, 2009
Phase 1 No animal influenza virus circulating among animals has been reported to cause infection in humans.
Phase 2 An animal influenza virus circulating in domesticated or wild animals is known to have caused infection in humans and is therefore considered a specific potential pandemic threat.
Phase 3 An animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks.
Phase 4 Human-to-human transmission (H2H) of an animal or human-animal influenza reassortant virus able to sustain community-level outbreaks has been verified.
Phase 5 The same identified virus has caused sustained community level outbreaks in two or more countries in one WHO region.
Phase 6 In addition to the criteria defined in Phase 5, the same virus has caused sustained community level outbreaks in at least one other country in another WHO region.
Post-peak period Levels of pandemic influenza in most countries with adequate surveillance have dropped below peak levels.
Possible new wave Level of pandemic influenza activity in most countries with adequate surveillance rising again.
Post-pandemic period Levels of influenza activity have returned to the levels seen for seasonal influenza in most countries with adequate surveillance.

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Situation Reports


PAHO today hosted a teleconference with ministers of health from throughout Latin America and the Caribbean to exchange information and address questions about the Influenza A(H1N1) outbreaks. PAHO/WHO is mobilizing experts to assist Mexico and has provided its member countries with guidelines for case definition, the use of antiviral drugs, and the preparation and shipment of specimens for laboratory testing.

At least six countries have reported laboratory-confirmed human cases of the Influenza A(H1N1) A(H1N1): Mexico (26 cases, 7 deaths), the United States (64 cases, no deaths), Canada (8 cases), Spain (2 cases), the United Kingdom (2), and New Zealand (3). The Pan American Health Organization/World Health Organization (PAHO/WHO) advises countries not to restrict regular travel or to close borders. April 28, 2009.
Last Updated on Tuesday, 12 May 2009 04:49

Regional Office for the Americas of the World Health Organization
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